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HomeMy WebLinkAbout0740 f~. t{~Q~[~~~NTY /lA. / ~UGkp'OItItAS ~ ~I~QK C;iCUIt CO ' . 4~2~ , F1fD ~~~1-'^A ~ A~~ i l I l4 PM'1~ ~ • - . . ' " ~ ' i ~ _ MEM 1ERSEr STATE OEPART?+EN1 OF MEALTM ~xai r~~t h„~nt. CERTIFICATE OF DEATH sT~~c n~E N~~pc~ . ~ _ _ ~ ~.r" t ~ s_S'[=~~.-s.a '_L . .'1"^~ t, , . _ . _ i ~••~:lf 1. A.1~fkU! ff~.in IM,JJIeI IL~~N 2. S~a~ r~.~UATI.UI~OFA71f ! -•.oh OFctA~Fn Q ~Q - ! •~~'1 u1t ~1~~.o.f.,et? ~/Li/!// I`~ • i /I ~ ~C~ ~ /~f7~ cti4r _ ~ _ ?~at~ Col~v o~ Ra:e A~e r,~ if ~n.ter 1 Yr. il ~a1rr Hn. G. ha~r ol H~:~A ~~s d~c~as~d e~er in t'.~. Ara~ed hor~es~ G~/ bH ?~N~~~ 1.M..,tAt ho~s 9NI 1 (Y~i. wo. o. rnln,rwl fIJ ~e~~ r~• o~ Iari~ o/ ~n~.1 ~ ~%a ? ~ ~ - -l - A. ~1~rth~~l~te /1r~. 1c.rr~e e..on~.~1 ~ 9. Gr~ttn ol ~~~t c.~~ntiy~ t~. Al~:n~•!= ;;~e~t~ ~1aer~ed 11. S.cu1 4cur,iy ~o. ~~.~/~r7.~/~ US/Q ,~ao..et~~ D~~orccdj'; Q ~ • G ~17Q T - - - •ts~~tMCt 1: p1At k OF DtAIlI O~ 1)• L'Sl~A4 RF~IUF~t C((1 ~nsaw~wn re~~dencr bafwa ~Jni~~~on) ceun~Y St,u _~.-J S. cerrwr---U~?/d ` Gty' ~---~--ICBeck Aoa,an.! ~~re na~e)- e. Gtr ) . (CRaek Mrt a~t ~~~e ni~,r1 t+ao~ t ~Z Q Q~C ~r' e«p~ ~ T ~r ~ t _ • / _ %y t.~. , / N D r- e. ha~~~ ~n Ao•~•~i~l or ~r~~~rw~~~n ~ise srrca s~res~) d Sueei AQ.lrras If rur~l. P.O. Addres~} ~ H~,~~.~ ~ ~ 2 , G En/- ~~S!'/T9 ~ ~ /=lu~ ~3 r'r-' F . fnv~tut,nn _~v . 1~. l'iual U.cu~~tu.n~~~ l:eJ ~.l r..rl J~.nr Jrri.~~ n.,st oJ w.•1:~j li/r. •~rn ~J rrf~•rJ1 1~. K.nd o( bw~r~s. a Indr~ur ~a ~ ~ s y F~e~___ _ c,os~•.= r~ c,yFC- l!. P~~Ret's \~T? iG. K+aAtr'a 5lnden ~sme ` - ~vco_ S'r.9~~_ ~ 1~. I~fn~n.~n~'~ ~~a~ anA Ad,Lcas _ ~ll~~.Q~~c r-~~--cZ .S-~~ ~~~'~L ll~l. ~J . _ c.usc ~ IS. PART 1 Dt Aill ~A~ CAl>t.t~ NY E~r~i owl~ on~ riw~ har /a (~1. (I) ~~+Jfr/ Ajprosi~au~ ineerrit Dei.ean onsei ~nd lrah leraedi~u Ciusr f~/ _.~~Lt ~ ~`7 ~ ~ r _ '.~.-i„'~L ' rr/~ . ~ Con/,~ions. ~Jin~. rbu! puetol~l "~,~/5~~-~, ~ { bl, ~C~~3~ ~l.~:Kt~ L • ~n~r aa~ to~6ae crrfe •.Y~Y'. aar~et rb~ ~nrJ~.. .,~,.,~ws s~~. /Y~nj c~rti b~f Dut [o (U .?.r.w~ b l~~rA •-~+nl~r~~ PAA7 1! OIHfR CIGIIFICAX7 C(Y.CI~Il10VS . ' ; ...y~.w 19a. t~s ~ueop~r 19b. 11 ~ra, ~rre (~ed~n~s tonsidared perfoansd~ ie de[~minin~ c~~st ef lea~h? ; - Y.. t- ~ ~o Y.. r.o ecc o[w r i0a. Acc~dent S~~c~de H. ~~c~~e :uD. Uxe sn.! 11wr o( Injuir Mt. Her ~n~ury pecwtud IFnr~r aato•r a/ ~n;ar~ P~.t! o. 11 oJ Inn lal CJ Ci _ . !o t1~r b~it ol m~ ln:n.l~dRt M. TW. In~utr Occwre~i 10e. Plare of ln~urr t~ S~n w~6or~ bol•~. jQl. Citr. Tosn a Locat.on CoyM shilt at Aa 1~~(t ( o•.r. cta ttr~r~. o«< bte N~ ) r ~e ~ork t j a< <«k . ~ / 7 ~ . ~ :•ossc~~a~. ~ - I1. ! (a~tended. taamined) fAe dec~ased (trem. on) / to ~ ~nd l~~t ~av (hin. her) ~}i~e on ! e / ~ ~ ~ D~otb ot~ r•r~J at ~ A on tFi 1~?.- ~eatrJ aF.~i r: e~J to ~F~ br~t o! ~o.,~ (.da.. /.o•~ !Rt e~r~n arotr! - CChSUS~ :ls. Anrr.d~n Ph ,~tcd. Faan. ~ C PA s ~ ~ TRACT ~ y . _1 Y )-~_l Ilh. Ads~c~s ' I7c. D•ra S~Rnrd S~Rn~cure ~~1.~ ~ ~`C L C <~4 f ~~~1'~ ~~~-l~l ' ~'~V ~l !_'~~~~tJ~-i ~ t~ L C`~~ ~ ~`T C: , ~ 1~~ S~t.'. ~trr. ~t~or. Rert~~.~ i 2~6. Ctnetet ~ Ct~ a{..rj 1~rnt . ?je. I.et~r~ow ! C~tr S~ v h~J.'6C >l.t~ G.!'t~Cf~~: a~/f'i I1 ~'u a ~"jlfC rt L:~ z 1/'~i- ~J , 23d Nu:~~l ba~e b1o. Dwy ~'t. 2'4~. Funcr~l It..r_e . aa ~ / ; ~ 11b. Fvn~ra! 11.r...e.~td3t~u ~ C~C~ - J S ~ `l ~ ` ~u • ~ t-~~u,f;-' ~'-i% ~r ~ 1i . _r1 . , - ~ Id;. fur.rra! hu~.co~ S:~n.c•,::r h. . L~c~nce Ao. 21i. Rea,sar~r Isau~n~ Pe~mic = S;Frt~tute I~h. l~~to Rec'd. bp Loc~! -j- A _f~ ~ ~ ~ Re~~stur ! •c~. y4`-'l•~~LV_ !~f/y~-1~(~ / - t i ~ l s~ - - - - L~ • " - P` _x..f 'TI ` ,f~i _ . ~~FY~" ~ CTTY OF EI.1ZAnETH, N. 4' ~ OFFICE OF REGISTRAR OF YITAL STATISTICS ~ . . _ ~ r`~ . . , . ~o.u, THIS IS TO CERTIFY THAT THE FOREGOING lS A TRUE COPY OF A REC4RD IN MY OFFICL•. . . . ~ l ~ ? 3 n ; ~ ~ t.~-~}' ~ ` / ` ' 1 l~ ~ : 1 • ~bfistsl? M VILI Nstl~ Clty Nalt. ~WaMt~. N. • ~ ' e ' Warnie~: Do ~ot aaep~ tbis c+op~r ~s1ar d~e raiied aa1 d tbe Citt as[ ~i:~d..w !1L L ja a~l~Y,~+d ~nns... _ . ~ _ - - RETURN T0: Home State Title Co. 1950 Lee Road, Suite 105-8 G p~p~ ~ Winter Park, Florida 32789 5~~7x O ~q;;E